Medicaid managed care: the next generation?

Area of Science:

• Health Services Research
• Public Health Policy
• Healthcare Management

Background:

• Most U.S. states are implementing managed health care within the Medicaid program.
• Managed care represents a significant reform movement in state Medicaid initiatives.
• Anticipated future expansions of organized care systems in the U.S. healthcare landscape.

Purpose of the Study:

• To explore the acceleration of state investments in managed care planning and operations.
• To assess whether current managed care initiatives are meeting expectations.
• To examine the evolution and features of different managed care models.

Main Methods:

• Overview of state motivations for adopting managed care.
• Analysis of specific managed care plan features (e.g., Arizona's prepaid plan, New York's program).
• Discussion of challenges and questions based on literature and key informant input.

Main Results:

• Managed care in Medicaid is expanding, with diverse models emerging.
• Key questions arise regarding provider availability, network organization, and consumer safeguards.
• Challenges exist in adapting plans for diverse populations, including those with disabilities or chronic conditions.

Conclusions:

• State-supported managed care plans face significant barriers in meeting high expectations.
• Ongoing efforts in managed care expansion will continue to be critical under health care reform.
• Issues of access, quality of care, and consumer protection require continued attention.